Battle Of Sound Bites Reaches Health Care

In the battle of sound bites over President Bush’s expected veto of the children’s health insurance bill, the White House position boils down to this: Beware, beware — it’s the first step toward federalized health care.

Nonsense, say supporters from both sides of the aisle , who swear they would never vote for a bill that was the proverbial camel’s nose under a tent on government-run health care.

But a look back at the fine print of the 1993 “Hillarycare” debacle shows there may be a grain of truth in the Republican suspicions — and also demonstrates that the GOP believes there is still significant political power to be mined from one of the Clinton administration’s greatest political and tactical failures.

Back in 1993, according to an internal White House staff memo, then-first lady Hillary Rodham Clinton’s staff saw federal coverage of children as a “precursor” to universal coverage.

In a section of the memo titled “Kids First,” Clinton’s staff laid out backup plans in the event the universal coverage idea failed.

And one of the key options was creating a state-run health plan for children who didn’t qualify for Medicaid but were uninsured.

That idea sounds a lot like the current State Children’s Health Insurance Program, which was eventually created by the Republican Congress in 1997.

“Under this approach, health care reform is phased in by population, beginning with children,” the memo says. “Kids First is really a precursor to the new system. It is intended to be freestanding and administratively simple, with states given broad flexibility in its design so that it can be easily folded into existing/future program structures.”

The memo was sent to Politico by a Republican congressional office.

But the document is part of a trove of paperwork released as part of a 1993 lawsuit between the Clinton health care task force and the Association of American Physicians and Surgeons.

Hillary Clinton’s presidential campaign did not dispute the intent of the 1993 memo but pointed out that Clinton herself never publicly pushed the Kids First concept and that covering children first was just one of several options laid out during the mid-1990s debate.

The Clinton campaign also asserts that the 2008 campaign has learned lessons from 1993 and has embraced a health care plan that places the uninsured on subsidized private health plans.

Her campaign also says she never endorsed a government-run, single payer system.

“This whole notion about a government takeover [of health care] is absurd,” said Chris Jennings, who was a White House health care analyst and congressional liaison in 1993 and is now an outside adviser to the Clinton campaign. “[The SCHIP legislation] is financed by the government and contracted out to private insurers. It’s not a government takeover by any definition.”

Yet the legacy of “Hillarycare” and the intense debate this fall over SCHIP shows that both parties are still trying to come to terms with the future of American health care.

While Republicans warn of socialized medicine, Democrats are pushing for ways to cover the 47 million uninsured Americans without creating a single-payer, government-run bureaucracy.

For now, Democrats want to stay focused on children’s health care.

One staffer who worked for the Clinton administration and was involved in the creation of SCHIP says covering uninsured children was never seen as a step toward federalized health care.

“Maybe they [Republicans] fear this is the beginning of the next health care debate,” said Jeanne Lambrew, who was a senior health analyst at the National Economic Council during the Clinton administration and is now a fellow at the Center for American Progress. “But this is not socialized medicine. [SCHIP] was neer sold as comprehensive health reform.”

Democrats also point out that most children under SCHIP receive their benefits through private health care plans that contract with the states, not government-run plans.

But Republicans familiar with the 1993 memo say it shows that Democrats, and Clinton in particular, have always viewed children’s health care as the beginning of a march toward a federalized system.

“Everyone knows that Clinton has had government-run health care on her to-do list for at least a decade,” said Ryan Loskarn, a spokesman for the Senate Republican Conference. “The memo helps make clear the reason Democrats have pushed SCHIP legislation that includes coverage for adults and upper-income families. This isn’t about helping poor kids. For them, it’s about making big government even bigger.”

On Monday, White House spokeswoman Dana Perino said the Bush veto of SCHIP was needed because “we see that as a step towards more government-controlled health care.”

Indeed, Republicans are pushing hard to make the SCHIP debate about a larger question of whether Democrats are pushing for “socialized medicine,” a phrase meant to strike fear in voters.

And some Republicans have even invoked communist Cuba during the SCHIP debate.

“Fiscally responsible Republicans are being branded as anti-kids because we are trying to preserve the program for those children who would have no health care without it,” said Sen. Trent Lott (R-Miss.). “We are willing to fight against these bait-and-switch tactics aimed at cracking the door to government-run health care like they have in Cuba.”

Bush is expected to veto the SCHIP bill any day now, and the battle over the future of the program will continue as Congress attempts to override the veto. But Democrats, buoyed by the support of moderate Republicans, insist that the GOP argument about federalized health care is way off base.

“SCHIP was passed by a Republican Congress and signed into law by a Democratic president,” said Nadeam Elshami, a spokesman for House Speaker Nancy Pelosi (D-Calif.). “So the premise of the Republican argument is wrong.”